The family is still the very important unit of Philippine society, in spite of rumblings to the effect that its much vaunted closeness and solidarity is either slowly dissipating or was largely a myth, in the first place. Nowhere do you see family action rallied as effectively as when one member is taken ill mentally, emotionally, or physically. No matter what the motivation—whether it be from fear, fright, guilt, shame, loyalty, concern or simply a wish to be of help—family and immediate relatives are nearby. Usually the one who feels most responsible for, or obliged to, the patient, and possibly the most guilty, hovers the closest and has to be reckoned with in the management of the patient. Less frequently, a guilty-feeling relative may conspicuously stay away.

To a newcomer, Manila with its 15 square miles and over two and a half million people has the anonymity of any large, over-populated metropolis. To one who has lived in it for years, it has the interpersonal familiarity of a small town. To a psychiatrist practicing in Manila and residing in one of its suburbs, an encounter with a patient at the supermarket, in church, at a restaurant or night club and, in my case, at the beauty parlor or at PTA meetings is hardly surprising. The more the therapist’s social and economic class approximates that of his patients’, the greater is the likelihood of these off-hour meetings. I have had the experience of attending balls’ where the crowd included some of my patients. Being asked to dance, drink, and chat with them is only a natural part of the usual patterns of social interaction.

Outside of these chance situations, some patients will think nothing of going to the therapist’s house, for whatever reason or reasons. They may invite the therapist to their home for a birthday party, a housewarming, or a district fiesta. One may attach all kinds of psychological motivations to such gestures, but it also happens to be the cultural practice to invite friends to festivities. Otherwise, the person may feel remiss in his social obligations.

A comfortable medium in which the middle or upper class individual in Manila communicates at the present time is that of English, admixed in varying degrees with Tagalog. This “mixed” language was the medium of verbal exchange in therapy. Many patients learned English very early in life and very often spoke it ahead of Tagalog. However, the adolescent patients, boys and girls, were self-conscious about speaking English and spoke more Tagalog than English. Adolescent “slang” was expressed mostly in Tagalog. Young people also do not speak English as well as the older group I teredTëPat1eflts who spoke only one language and none of the other. One was a boy of 14 years from Bulacan, who talked in deep, literary Tagalog. At the other extreme was a young housewife who, although she grew up in Manila, spoke English all her life; she reacted with faint amusement whenever the therapist spoke a Tagalog word or phrase. It was as if the language ‘was completely foreign to her.

One set of communication repertoire which these patients appeared to use widely and richly was that of the non-verbal variety. They seemed to be so skillful at this that the very essence of the psychotherapeutic methods, i.e., “to put into words,” was often in dang of being thwarted. Many times, words were at once magical and meaningless; non-verbal communication then became more meaningful and reliable.

Some non-verbal messages came through loud and clear. One sharp look of scorn, one cold glance of congealed anger were enough to turn my blood cold. The woman in tears, her hair dishevelled, slumped in the chair, heels of her unshod feet scraping the top the foot rest, needed no words to announce her state of frustration. The male patient who unabashedly undressed the therapist just by looking at her did not know what being subtle or surreptitious means. The male adolescent with his movements in painful slow motion, repetitively pulling up his socks, straightening his collar while his shoulders stiffen; or the female adolescent, one hand held near the mouth, head held down slightly, the eyes with the look of a cornered fawn, and shoulders softly and alternately swaying—both eloquently conveyed the inner state of tension caused by heightened self-consciousness.

A detailed description of the analysis of my therapeutic experiences with the patients in this study deserves more time and space than feasible at this tune. It will indeed be a tour tie force if it is to be of value in making correct assumptions about the applicability and effectiveness of psychoanalytically-based techniques with non-Western patients. Be that as it may, I hope that the observations and interpretations described in this chapter may be helpful to the extent that they might serve as springboards for further discussions and comparisons with the findings of colleagues, particularly Filipino and Asian psychiatrists, involved in the practice of psychotherapy in their home countries.